Thromboembolic event rate in paroxysmal and persistent atrial fibrillation: Data from the GISSI-AF trial

Marcello Disertori, Maria G. Franzosi, Simona Barlera, Franco Cosmi, Silvia Quintarelli, Chiara Favero, Glauco Cappellini, Gianna Fabbri, Aldo P. Maggioni, Lidia Staszewsky, Luigi A. Moroni, Roberto Latini

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Background: Few data on the thromboembolic (TE) risk of paroxysmal and persistent atrial fibrillation (AF) are available. This study aimed to assess the incidence of TE events in paroxysmal and persistent AF.Methods: We performed a subset post hoc analysis of 771 patients with paroxysmal and 463 with persistent AF enrolled in the multicenter, prospective, randomized, double-blind, placebo-controlled GISSI-AF trial - comparing the efficacy of valsartan versus placebo in preventing AF recurrences - where the choice of antithrombotic treatment was left to the judgment of the referring physician. TE and major outcome events were centrally validated. AF recurrences were detected by frequent clinic visits and a transtelephonic monitoring device with weekly and symptomatic transmissions.Results: Eighty-five percent of patients had a history of hypertension, and the 7.7% had heart failure, left ventricular dysfunction, or both. The mean CHADS2 score was 1.41±0.84. TE and major bleeding events were observed at a low incidence among the overall population at 1-year follow-up (0.97% and 0.81%, respectively). The univariate and multivariable analyses revealed no statistically significant differences in the incidence of TE, major bleeding events or mortality in paroxysmal and persistent AF patients. TE events were more common among women than men (p=0.02). The follow-up examination showed under- or overtreatment with warfarin in many patients, according to guideline suggestions. Warfarin was more frequently prescribed to patients with persistent AF (p2 score (HR 2.93; CI 95%; 0.8-10.9; p=0.11).Conclusions: TE and major bleeding events showed a very low incidence in the GISSI-AF trial population, despite under- or overtreatment with warfarin in many patients. TE events had a similar rate in paroxysmal and persistent AF.Trial registration: Trial registration number: NCT00376272.

Original languageEnglish
Article number28
JournalBMC Cardiovascular Disorders
Publication statusPublished - Apr 15 2013


  • Atrial fibrillation recurrences
  • Paroxysmal atrial fibrillation
  • Persistent atrial fibrillation
  • Thromboembolic risk
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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